不同气道管理方式对气管插管早产儿SpO_2及PaCO_2的影响

Effect of different kinds of Airway management on SpO_2 and PaCO_2 of premature infants with endotracheal intubation

目的:探讨三种不同气道管理方式对气管插管呼吸窘迫综合征(NRDS)早产儿吸痰前后经皮血氧饱和度(SpO2)和动脉血二氧化碳分压(PaCO2)的影响,筛选更为有效的气道管理方式。方法:将气管插管机械通气的NRDS早产儿60例随机分为单纯密闭式吸痰组(A组)、密闭式吸痰加肺复张组(B组)及开放式吸痰加肺复张组(C组)各20例,分别应用不同的吸痰方法进行吸痰和气道管理,观察三组患儿吸痰前后SpO2及PaCO2变化。结果:吸痰前三组SpO2之间比较差异无统计学意义,A组吸痰后1 min SpO2较吸痰前1 min降低,差异有统计学意义,吸痰后3 min仍未恢复至吸痰前水平;B组、C组吸痰后1 min SpO2下降不明显,各自与吸痰前1 min比较差异无统计学意义,但均高于A组;吸痰后3 min B组、C组SpO2均恢复至正常水平。吸痰前1 min三组PaCO2差异无统计学意义。C组吸痰后15 min与吸痰前比较,PaCO2明显下降。吸痰后15 min PaCO2C组与A组比较差异有统计学意义,前者低于后者;C组与B组比较差异无统计学意义。结论:在联合应用肺复张的情况下,开放式吸痰与密闭式吸痰对肺氧合的影响没有明显差别。开放式吸痰与密闭式吸痰各有优缺点,开放式吸痰清理气道更彻底,但更容易造成肺容量下降,结合应用肺复张能克服其不足。痰多粘稠、CO2储留宜选择开放式吸痰,同时加用肺复张克服肺容量减少和功能残气量下降引起的低氧血症。痰液稀薄量少、PaCO2正常,则可采用密闭式吸痰,尽量减少开放气道引起的肺容量和功能残气量的减少。

Objective To probe into influence of 3 different airway managements on SpO 2 and PaCO 2 of premature infants with NRDS,in order to search for more effective management of the airway.Method Sixty intubated and ventilated preterm infants with NRDS were randomized into three groups.Group A（n = 20） used closed suctioning,group B（n = 20） used closed suction with lung recruitment maneuver and group C（n = 20） used open suctioning with lung recruitment maneuver.The changes of SpO 2 and PaCO 2 in 3 groups were observed before and after suctioning.Results There were no significant differences about SpO 2 among the three groups before suctioningSpO 2 of Group A 1min after suctioning was lower than that 1 min before suctioning and it did not restore at 3min after suctioning to reach the level before suctioning.There was no significant change of SpO 2 in Group B and group C at 1min before and after suction,but SpO 2 of two groups was both higher than that of group A.At 3min after suction SpO 2 of B group and group C remained normal levels.There were no significant differences about PaCO 2 among the three groups at 1min before suctioning.At 15 min after suctioning PaCO 2 of group C was significantly lower than that before suctioning.At 15 min after suctioning PaCO 2 of group C was significantly lower than that of group A,but there was no difference between group C and group B.Conclusion There are no significant differences of affecting on Oxygenation between closed system suction with lung recruitment maneuver and open system suction lung recruitment maneuver.Open system suction cleans airway more thoroughly than closed system suction,but more likely to cause decreased lung capacity.Lung recruitment maneuver can overcome the defect of open suction which is better for the babies with more thick phlegm,but closed suction is prior to the babies with less and thin sputum.